RESULTS OF MITRAL-VALVE RECONSTRUCTION EXPERIENCE OF HOPITAL-ERASME, ULB, BRUSSELS

Background. Reconstructive surgery of the mitral valve has been an alt ernative to mitral valve replacement in patients with mitral regurgita tion. In order to evaluate the early results of mitral valve reconstru ction, 38 consecutive cases were analyzed. Methods. Between January 19 85 and May 1993, 38 patients with mitral valve incompetence were treat ed with a system of reconstructive techniques. Nineteen (52%) of the p atients were in NYHA functional class II and seventeen (45%) in class III or IV preoperatively. The cause of the mitral disease was degenera tive in 25 (66%), rheumatic in 6 (15%) and ischaemic in 5 (13%) patien ts. Isolated mitral valve repair was performed in 25 patients (66%); t he remainder underwent associated procedures that included a myocardia l revascularization in 9 patients (23.6%). Thirty-eight patients (100% ) underwent a ring annuloplasty. Resection of the posterior leaflet wa s performed in 24 patients (63%). Results. There was one operative dea th (2.6%) and two late deaths (5.3%). Postoperatively, four patients s ustained embolic events (incidence 10.5%). Six patients (15.8%) were p recociously reoperated within the following month; two patients requir ed valve replacement, one had mediastinitis and three other ones neede d a pericardial drainage. Patients routinely received acenocoumarol an ticoagulation for two months. Mean follow-up was 33 months (range 6 to 104) and one patient was lost to followup. Two years actuarial surviv al was 91.4%. There were no thromboembolic complications in the follow -up period. No patient was reoperated for valvular insufficiency beyon d this time limit. One patient had late endocarditis and has been reop erated for mitral replacement (2.6%). After surgery, 34 survivors (89. 5%) were in the NYHA functional class I or II. Conclusions. These resu lts demonstrate that mitral valvuloplasty is associated with lower ope rative mortality rates. Preservation of the mitral valve mechanism rai sed the performance of the left ventricle after reconstructive surgery . The incidence of reoperation and thromboembolism was low.